Risks and benefits of pancreaticoduodenectomy in patients aged 80 years and over

PurposeThe frequency of pancreaticoduodenectomy is increasing in oldest old patients owing to population aging. We aimed to clarify the clinical significance of pancreaticoduodenectomy in patients aged >= 80 years with multiple underlying diseases.MethodsA total of 649 consecutive patients who underwent pancreaticoduodenectomy from April 2010 to March 2021 in our institute were divided into two groups according to their age: >= 80 years (51) and <= 79 years (598). We compared mortality and morbidity between the groups. The age-related prognosis was analyzed in 302 patients who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma treatment.ResultsThere were no significant differences in morbidity (Clavien-Dindo classification grade III or higher; P = 0.1300), mortality (P = 0.0786), or postoperative hospital stay (P = 0.5763) between the groups. Patients aged >= 80 years, who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma, had shorter overall survival than those aged <= 79 years (median survival time, 16.7 months vs. 32.7 months; P = 0.0206). However, the overall survival of patients aged >= 80 years who received perioperative chemotherapy was comparable to that of patients aged <= 79 years (P = 0.9795). In the multivariate analysis, the absence of perioperative chemotherapy was identified as an independent prognostic factor, while age >= 80 years was not. Perioperative chemotherapy was the sole independent prognostic factor in patients aged >= 80 years who underwent pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.ConclusionsPancreaticoduodenectomy is safe for patients aged >= 80 years. The survival benefits of pancreaticoduodenectomy for patients with pancreatic ductal adenocarcinoma aged >= 80 years might be limited to those who can receive perioperative chemotherapy.